Provider Demographics
NPI:1790285229
Name:PREFERRED VASCULAR SERVICES SOUTHWEST
Entity Type:Organization
Organization Name:PREFERRED VASCULAR SERVICES SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-597-2010
Mailing Address - Street 1:9140 CORSEA DEL FONTANA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4397
Mailing Address - Country:US
Mailing Address - Phone:239-597-2010
Mailing Address - Fax:239-597-2313
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW STE 314
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7100
Practice Address - Country:US
Practice Address - Phone:404-349-7770
Practice Address - Fax:404-349-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty